Pancreatic Panniculitis Caused by l‐Asparaginase Induced Acute Pancreatitis in a Child with Acute Lymphoblastic Leukemia

Abstract

Panniculitis caused by L-asparaginase induced acute pancreatitis is an unusual condition. We report a case of a 7-year-old Thai boy with underlying acute lymphoblastic leukemia who developed pancreatic panniculitis caused by L-asparaginase administration. During the second week of induction chemotherapy, the patient developed acute pancreatitis with septic shock. Two weeks later he developed multiple subcutaneous nodules on the abdominal wall. Skin excisional biopsy showed the typical histopathological features of pancreatic panniculitis. Acute pancreatitis improved after 3 weeks of conservative treatment. The skin lesions resolved spontaneously within 1 month.

Pancreatitis, panniculitis, polyarthritis syndrome successfully treated with EUS-guided cyst-gastrostomy

“…Its etiology is hypothesized to involve the release of pancreatic enzymes into systemic circulation, leading to lipolysis and inflammation in distant soft tissue sites. [1][2][3][4][5] Pancreatic pathologies such as acute and chronic pancreatitis, pancreatic carcinoma, pancreas divisum, and pancreatic vascular fistulas have all been implicated. 2 Patients with pancreatic panniculitis can present with tender, ill-defined, erythematous nodules located on the lower extremities but also involving the thighs, buttocks, abdomen, or scalp.…”

Pancreatic fat necrosis in a 10‐year‐old girl: A case report and review of the literature

“…Pancreatic fat necrosis may occur prior to, concurrent with, or after onset of pancreatitis in both children and adults . Serum lipase and amylase elevations are not predictive of the clinical course of PFN, and cutaneous lesions may predate active panniculitis by up to 3 weeks . Circulating amylase, lipase, trypsin, and phospholipase can purportedly leak into subcutaneous fat and hydrolyze the neutral fat .…”

“…To date, 5 children with pancreatitis and cutaneous PFN have been reported . Table outlines their features.…”

“…Pancreatic fat necrosis (PFN) arises in 2%‐3% of adults with pancreatitis, typically in males . In children, this incidence is presumably lower although pancreatitis is also less common than in adults.…”

Pancreatitis in adult with acute lymphoblastic leukemia using L-asparaginase and simvastatin: case report and systematic review

“…There is also the risk of developing chronic sequelae, such as prolonged pancreatic exocrine insufficiency. 1,[5][6][7][8] Case r Case r Case r Case r Case re e e e epor por por por port t t t t…”